4:12 PM Abstract No. 207 Transjugular Versus Transfemoral Transcaval Liver Biopsy: a Single-Center Experience in 500 Cases

To compare 286 consecutive transfemoral transcaval (TFTC) liver biopsies to 214 consecutive transjugular liver biopsies (TJLB) as to technical and histopathologic success rates, complication rates and fluoroscopy times at a single tertiary care institution. TFTC is an alternative to TJLB, where hepatic tissue is directly obtained through the intrahepatic inferior vena cava via a femoral venous approach. The medical, procedural, and radiologic records of patients who underwent TFTC liver biopsies between February 2014 and December 2018 were reviewed. Similarly, records of patients who underwent TJLBs were reviewed for cases between December 2010 and January 2014, the last TJLB case before the adoption of the TFTC technique. Procedural complications were classified according to the Society of Interventional Radiology guidelines. Comparative statistical analyses were performed with a two-sample test or Wilcoxon ranked sum test for continuous variables, chi-square test or Fisher’s exact test for categorical variables, when appropriate. 286 TFTC core-needle liver biopsies and 214 TJLBs were included. TFTC versus TJLBs data are presented respectively as follows: technical success rates 99% (283/286) versus 100% (214/214); histopathologic success rates 96.8% (275/286) versus 95.8% (205/214); fragmentation rates 4.2% (12/285) versus 17.4% (37/214), (P <0.0001); major complication rates 1.4% (4/284) versus 5.6% (12/284), (P = 0.0088). The TFTC group had no hepatic related bleeds while the TJLB group had six significant hepatic bleeds requiring reintervention. Mean fluoroscopic time for TFTC was 5.5 (IQR 3.9-8.6) minutes and for TJLBs was 8.1 (IQR 5.2-13.1) minutes, (P <0.0001). This single institution study shows that TFTC liver biopsies have lower major complication rates, lower fragmentation rates, and lower fluoroscopy times than traditional TJLBs. Our experience suggests that TFTC is a feasible and safer approach than TJLBs. These factors should be taken into consideration when patients require transvenous liver biopsy.